| General Illness Information |
Common Name: |
HIV,
AIDS |
|
Medical Term:
|
HIV, Human Immunodeficiency Virus Infection |
| Description: |
A chronic infection with a variable course ( about
10 years from the time of infection for 50% of persons to develop
AIDS).
HIV
infects cells with CD4 receptors, most notably the CD4 lymphocytes
(also called T4 or T helper cells).
Infection causes cell death and a decline
in immune function resulting in opportunistic infections,
malignancies, and neurologic problems.
|
| Causes: |
It is caused by the Human immunodeficiency virus , a retrovirus
|
| Prevention: |
Avoid unscreened blood products; avoid
unprotected sexual intercourse; use condoms; avoid injection drug
abuse; avoid contact with body fluids of persons infected with
HIV. Treat all needle-stick injuries. |
| Signs
& Symptoms |
|
Early:
Acute infection: Mononucleosis-like syndrome with fever,
rash, myalgia, and malaise a self-limited syndrome occurring
about 6-8 weeks postinfection, associated with the development
of HIV
antibody
· Asymptomatic infection: Follows
initial infection; variable duration
· Persistent generalized lymph node
enlargement
· Other diseases:
Fever lasting more than one month, involuntary weight loss
of more than ten percent baseline weight, persistent diarrhea,
skin rash, severe chronic fatigue
Dementia, myelopathy or peripheral neuropathy not explained
by other illness
Secondary manifestations:
Secondary infectious disease:
Pneumocystis carinii pneumonia; chronic
cryptosporidial diarrhea; cerebral toxoplasmosis;
extra-intestinal Strongyloides; isosporiasis; esophageal,
bronchial/pulmonary candidiasis; cryptococcosis;
histoplasmosis; coccidioidomycosis; disseminated mycobacterial
disease; cytomegalovirus disease; chronic mucocutaneous or
disseminated herpes simplex; progressive multifocal
leukoencephalopathy.
Oral hairy leukoplakia, dermatomal zoster,
nocardioses, tuberculosis (pulmonary), recurrent salmonella
bacteremia, oral candidiasis.
Secondary cancers:
Kaposi's sarcoma, non-Hodgkin's lymphoma, and primary brain
lymphoma, invasive cervical cancer.
|
|
| Risk Factors |
|
Multiple sexual partners.
|
|
Exposure of hospital
workers and laboratory technicians to blood, feces and urine
of HIV positive patients. Greatest risk is with an accidental
needle injury.
|
|
Infants born to mothers
with HIV infection.
|
|
Intravenous drug abuse.
|
|
Multiple transfusions
(before 1985).
|
|
| Diagnosis & Treatment |
|
First Screening test:
ELISA (Blood test)
Sensitivity and specificity
> 98%
Reported as reactive or non-reactive. Reactive tests
should be repeated.
Confirm repeatedly reactive tests by another test
(most commonly the Western Blot).
Other investigations:
CBC with differential and platelets; ; CD4 absolute count
and %lymphocytes CD4; hepatitis B ; chest x-ray; TB test
with control; HIV-1
RNA viral load; toxoplasmosis IgG, CMV IgG, Pap smears
in females
|
| General
Measures: |
|
Consultation with an
experienced HIV
expert is strongly encouraged. |
|
| Medications: |
|
Nucleoside reverse transcriptase inhibitors:
à
Abacavir (ABC, Ziagen)
à
Didanosine (ddI, Videx)
à
Lamivudine (3TC, Epivir)
à
Stavudine (d4T, Zerit)
à
Zalcitabine (ddC, Hivid)
à
Zidovudine (AZT, Retrovir)
· Protease inhibitors:
à
Amprenavir (Agenerase)
à
Indinavir (Crixivan)
à
Nelfinavir (Viracept)
à
Ritonavir (Norvir)
à
Saquinavir (Fortovase)
· Non-nucleoside reverse
transcriptase inhibitors:
à
Delaviridine (Rescriptor)
à
Efavirenz (Sustiva)
à
Nevirapine (Viramune)
· Current standard requires
the use of 3 drugs to attempt to prevent the resistance.
These drugs have significant risk of
toxicity, and significant drug interactions. Regular expert
supervision is necessary.
|
|
| Activity: |
|
No restrictions. Regular exercise is
encouraged.
|
|
| Diet: |
|
No restrictions. Good nutrition
is encouraged. Vitamin supplementation is advised. |
|
| Possible
Complications : |
|
Opportunistic infections
Neuropsychiatric symptoms
HIV-associated
malignancies
Medication side -effects.
|
|
| Prognosis |
|
When untreated,
HIV
infection leads to AIDS. The life expectancy is then two to
three years.
AIDS defining
opportunistic infections usually do not develop until CD4 count
drops to less than 200.
Potent
antiretroviral regimens may delay or reverse immune dysfunction.
|